 | | Atriumfibrilleren – in welke richting beweegt het onderzoek zich ? Isabelle C Van Gelder University Medical Center Groningen The Netherlands |
|  | | AF – future research |
|
 | | Classification of AF |
|  | | Clinical events affected by atrial fibrillation |
|
 | | Associated diseases |
|  | | Systolic blood pressure and new AF |
|
 | | Rhythm control |
|  | | Amiodarone the best: SAFE-T |
|
 | | Prediction of successful rhythm control |
|  | | PA-tdi |
|
 | | New onset AF associated with severity of structural remodeling |
|  | | Diagnostics to evaluate atrial substrate for AF |
|
 | | AFFIRM and RACE |
|  | | Atrial remodeling starts far before first AF |
|
 | | ACE-I and ARBs for prevention of AF |
|  | | Primary prevention in hypertensives and LVH |
|
 | | Primary prevention in hypertensives and LVH |
|  | | Primary prevention with ACE-I early after AMI with LV-dysfunction |
|
 | | Future goal: primary prevention in patients at risk |
|  | | Future goal: upstream therapy for secondary prevention |
|
 | | GISSI AF: secondary prevention in AF and risk factors with valsartan |
|  | | Time to first recurrence of AF |
|
 | | GISSI AF: secondary prevention with valsartan |
|  | | ACE-I/ ARB + amiodarone is superior |
|
 | | RACE 3 Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure |
|  | | Hypothesis RACE 3 |
|
 | | Endpoints |
|  | | Inclusion criteria |
|
 | | Inclusion criteria |
|  | | Definitions |
|
 | | Inclusion |
|  | | Reduction of CV morbidity and mortality |
|
 | | Cardiovascular events in AF patients (RACE) |
|  | | MACCE and hospitalization in 5333 AF patients Euro Heart AF Survey |
|
 | | Do not shoot the messenger AF Get the message that AF represents vascular disease |
|  | | Prevention CV morbidity and mortality |
|
 | | New treatment goals in AF and unmet need |
|  | | New treatment goals in AF and unmet need |
|
 | | Eurides, Adonis: Dronedarone for rhythm control |
|  | | Dionysos: Dronedarone vs Amiodarone |
|
 | | Erato: Dronedarone for rate control |
|  | | ATHENA – endpoints |
|
 | | ATHENA: Dronedarone for prevention CV morbidity and mortality |
|  | | ATHENA – primary endpoint |
|
 | | ATHENA – death from cardiovascular cause – 29% |
|  | | ATHENA – 1st hospitalization due to CV events – 26% |
|
 | | Dronedarone reduces CV hospitalizations: – 26% |
|  | | ATHENA - risk of stroke – 34% |
|
 | | Dronedarone – safety: adverse events |
|  | | Potential ways in which dronedarone could influence morbidity and mortality |
|
 | | Upstream therapy for prevention CV morbidity and mortality |
|  | | Conclusions |
|
 | | Thank you for your attention |
|  | | Conclusions dronedarone |
|
 | | Dronedarone – multiple benefits |
|  | | Upstream therapy – applying drugs that ameliorate the substrate of AF |
|
 | | Why upstream therapy ? |
|  | | AF – natural time course |
|
 | | Endpoints/ outcome parameters in AF trials |
|  | | Prevalence of atrial fibrillation |
|
 | | Primary prevention of AF |
|  | | Identify patients at risk for AF |
|
 | | Identify patients at risk for AF |
|  | | Diastolic heart failure and risk on AF |
|
 | | Identify patients at risk for AF |
|  | | Non ion channel AADs may inhibit pathways that promote atrial remodeling |
|
 | | Vraag 2 |
|  | | Secondary prevention with ACE-I/ARB and amiodarone |
|
 | | GISSI AF: secondary prevention in AF and risk factors with valsartan |
|  | | Time to first recurrence of AF |
|
 | | GISSI AF: secondary prevention with valsartan |
|  | | Vraag 3 |
|
 | | Statins for the prevention of AF |
|  | | Statins and AF: a meta-analysis |
|
 | | GISSI HF: primary prevention in HF patients with rosuvastatin 10 mg |
|  | | GISSI HF |
|
 | | GISSI HF |
|  | | GISSI HF: role of statins |
|
 | | GISSI HF: role of statins |
|  | | Upstream therapy: future |
|
 | | RACE 3 Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure |
|  | | Conclusions |
|
 | | Conclusions |
|  | | Interdependence of AF mechanisms |
|
 | | HATCH score to predict AF progression |
|  | | AF is a progressive disease |
|
 | | ‘My take home message’ |
|  | | MACCE and hospitalization in 5333 AF patients Euro Heart AF Survey |
|
 | | Indication for LA Catheter Ablation |
|  | | Ablation when structural heart disease is present |
|
 | | Modulating factors for AF |
|  | | Risk of AF in 10 years |
|
 | | HATCH score and AF progression 1 Year AF progression in 1219 paroxysmal AF patients, EuroHeartSurvey on AF |
|  | | Primary prevention of AF |
|
 | | Diagnostics to evaluate atrial substrate for AF |
|  | | Primary prevention of AF |
|
 | | Identify patients at risk for AF |
|  | | Identify patients at risk for AF |
|
 | | Possible new risk factors |
|  | | Nieuwlaat R et al, Eur Heart J 2008 |
|
 | | Efficacy of Amiodarone and Dronedarone in preventing recurrence of AF |
|  | | AF – the epidemic |
|
 | | Rhythm control |
|  | | Was Antiarrhythmic Effect Important? Permanent AF Patients |
|
 | | Cardiovascular events in permanent AF (RACEII) |
|  | | Rhythm control |
|
 | | Prediction of successful AF ablation |
|  | | Prediction of successful AF ablation |
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